Approaching hip pain differently.

You might have fewer struggles with your hip pain clients if you start approaching the hip joint as the intersection of a long pole (the leg) with a ball on the end (the femoral head) and the pelvis' acetabulm/labrum sitting/balancing on top of the ball.
The game is to get the stick (the leg) stable and stiff enough that you can control the positioning of the frontal, sagittal and rotational planes of that ball on the end, and achieve enough control/skill, strength, stability, endurance of the interface of the pelvis socket (the pelvis' acetablum/labrum) on top of this ball. The key to success in this area is the understand that the pelvis, and the body mass above it, is terribly disadvantaged to find controlled equilibrium on top of the ball (femoral head). Thus, achieving sufficient skill of the muscles bridging the two, adequate endurance in them to last the duration of the challenges, and certainly sufficient strength of those muscles to control shear, compression, stability and controlled mobility are key components to successful and pain free hip function.
One has to think of things in a closed chain, one's limb is fixed on the ground, and one needs to see that the game is to control the pelvis and the massive entire torso mass on top of this small ball in a controlled fashion, while we are moving and changing position.
This is the game.

*This is why single leg lifts and rehab are so key in the success of a client. Remember, gait and running and most sports are for the majority of the time, spent in single leg loading.

Shawn Allen, the other #gaitguys

#gait, #thegaitguys, #gaitproblems, #gaitcompensations, #gaitanalysis, #hippain, #hipbiomechanics, #Singlelegloads, #unilateraldeadlifts, #stancephase,

photo, courtesy of pixabay.com

https://pixabay.com/en/soccer-football-soccer-players-kick-1457988/?fbclid=IwAR13Laep8KM-w4KaVl8Ip9vyz7Svk6BXbGgEE_UkSYU-3eoAV1suHtsbi80

An Alternate View of Crawling and Quadrupedal Motor Patterns: A Correlation to Free Solo Mountain Climbers ?

The one you haven’t heard about.

On janurary 15, 2014 Alex Honnold, Free-Soloed El Sendero Luminoso (The Shining Path) in El Potrero Chico, Mexico in a little over 3 hours. The climb rises 2500 feet to the summit of El Toro. At the time, it was considered to possibly be the most difficult rope-less climb in history, . . . until El Capitan.

Quadruped Patterns: Part 1, Redux
If you have been with us here at The Gait Guys for awhile, you will have read some articles where we discuss quadrupedal gait (link: Uner Tan Syndrome) and also heard us talk about CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs without sensory feedback. You will have also read many of our articles on arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during gait and running gaits.

Lets get into it, full blog post here,

https://www.thegaitguys.com/thedailyblog/an-alternate-view-of-crawling-and-quadrupedal

An Alternate View of Crawling and Quadrupedal Motor Patterns: A Correlation to Free Solo Mountain Climbers ?

Quadruped Patterns: Part 1

In the last 3 years, if you have been with us here at The Gait Guys that long, you will have read some articles where we discuss quadrupedal gait (link: Uner Tan Syndrome) and also heard us talk about CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs without sensory feedback. You will have also read many of our articles on arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during gait and running gaits. Through these articles, we have also eluded to some of the fruitless aspects of focusing solely on retraining arm swing in runners because of the deep neurologic interconnectedness to the lower limbs and to the CPG’s.
IF you are interested in any of these articles we have written please feel free to visit our blog and type in the appropriate words (Uner Tan Syndrome, arm swing, cerebellum, cross over gait) into the Search box on the blog.

Here we briefly look at interconnected arm and leg function in crawling mechanics in a high functioning human (as compared to the Uner Tan Syndrome) in arguably the best solo free climber in the world, Alex Honnold. Here we will talk about the possible neurologic differences in climbers such as Alex as compared to other quadruped species. Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. The interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Alex however, we need to keep it mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates and those with Uner Tan Syndrome. This is obvious to the observer not only in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences. To be more specific, a climber keeps the COM within the 4 limbs and close to the same surface plane as the hands and feet (mountain) while a primate, human or Uner Tan person will “tent up” the pelvis and spine from the surface of contact.

What some of the research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination. This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns. What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.

The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. Certainly we need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. We will keep you posted. Next week we will follow up on this quadrupedal topic with a video that will blow your mind ! So stay tuned !

Shawn and Ivo
The Gait Guys

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML, Brigadoi S, Schena F, Tosi P, Ivanenko YP.

J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.

"The slow creeping death of our wonderment."

Something different for a Sunday morning.

"The slow creeping death of our wonderment."

Today, kinda random thoughts, but not entirely. It is about our kids and their possible progressive loss of wonderment from all of this technology around them. Which, I guess, is also germane to us adults as well. It is about climbing trees, sitting in silence, about letting ideas flow, about thought experiments, where many great things percolate from deep inside our minds. It is about taking chances, free thinking, stepping to the edge, and being alright with being wrong.

I wrote this back in 2017 on my personal website (shawnallen.net). Seemed valuable to share today after a soft attack on fresh ideas.

On the topic of "wonderment" . . . .

I have to admit, some of my greatest clinical insights as a student of human movement have come from long periods of wonderment. What intrigues me is when logically proposed wonderment is attacked. What I am referring to is the rare, yet often enough, occurrence on my clinical blog (thegaitguys.com) where a fresh idea or theory, a thought perhaps admittedly without a solid research base is attacked as unsubstantiated. Sometimes, I am left rolling my eyes when some purist in the comments section might write, "show me the research and data on this idea, otherwise it's crap". Questioning something unsubstantiated is just fine with me, but attacking is not. When did fresh ideas become crap, unworthy of consideration? Research does not necessarily set up our rules and guidelines to follow, it is perhaps more so there to foster our present knowledge on a topic, to afford us with information to base choices and thoughts upon. If someone thinks that the up to date research on a topic is the template, then they will be stuck in time. Growth will evade them. I feel sorry for those people, I feel sorry that their biases were not confirmed, that their belief system has felt questioned and rattled. I fear for these folks, they will never develop their own thoughts, never their own moments of Einsteinian genius. They will merely be followers of other's research and work, never free thinkers, and certainly never become those researchers who had just the same sort of questions and wonderment and yet sought out to prove or disprove their wonderment. The world has proven over and over again that the free thinkers, the wonderers, are often the leaders, the risk takers, the inventors, the forgers of human progress. And, they are handsomely rewarded for their time, their risks of looking like a fool. I feel blessed when I can steal a mere shot glass of insight from the deep wells of these types of people. All great ideas first started with a thought, a hypothesis, a wonderment. Just because no one has written a paper on a topic does not mean the ideas are invalid or not worthy of consideration. This is how we all grow, these wonderments, it is where all good research paper hypotheses begin, it is where we can leap to deeper insights and learn from each other. Without wonderment we remain stagnant, never to move farther ahead. The key is to not get trapped too firmly in our own biases, always looking for confirmation of said biases. This is a dark place where we all can fail to grow, and at times, I am guilty as charged, I admit it." -Shawn Allen

There is more in the link below. Click if you wish.

https://www.shawnallen.net/dailyblog/2017/9/24/the-slow-creeping-death-of-our-wonderment

Shawn Allen, the other gait guy
#gait, #wonderment, #thoughtexperiment, #learning, #gaitproblems, #gaitanalysis, #research, #personalgrowth

Novice runners show greater kinematic changes with fatigue.

Soft face palm here, most of us could have assumed this, but it is always nice to see a study to prove it.
This is the stuff we see in practice all the time. Throw some asymmetry and pathomechanics on top of these runners and then allow them to fatigue and it is a perfect storm.
The point today is that these are not the hard patients to help, it is the seasoned runners, the ones on their 30th marathon if you will. They have ground into their system deep durability and adaptability. They have learned to accommodate to loads under fatigue, they adapt to the environment well. These are the runners who might say to you, "at mile 15 i was getting some lateral hip pain, and then through mile 16 it went away". What did they do to manage to do that? That is your puzzle to solve Sherlock.
This is the game we/you play everyday.
What went wrong, find the source, prevent it next time, find the adaptive pattern, tease out the asymmetry, find the strategy they deployed.
Oh, and one more time, what you see them doing on the treadmill, in your gait analysis, is their adaptable pattern, not their problem.

The gait guys, Shawn and Ivo

#gait, #gaitanalysis, #gaitproblems, #novicerunners, #fatigue

Novice runners show greater changes in kinematics with fatigue compared with competitive runners

Article in Sports Biomechanics 17(3):1-11 · July 2017

https://www.researchgate.net/publication/318640014_Novice_runners_show_greater_changes_in_kinematics_with_fatigue_compared_with_competitive_runners?fbclid=IwAR0t-fAr8fzh1y6MQa0c35jbzwkrJfNb8QUlpdLpxyq0N3TuioOJLju0FOY

Femoral Anteversion?

image source: Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

Here is a free, full text article that talks about using 3D CT for a precise measurement of things like femoral and tibial torsions and versions. Remember that this will directly influence the amount of internal and external rotation of the hip, which will have a direct influence on gait. Remember you need 4-6 degrees of internal and external rotation to ambulate normally

Dr Ivo Waerlop, one of The Gait Guys

Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

#gait, #measurement, #femoraltorsion, #femoralversion, #antetorsion, #anteversion, #retrotorsion, #retroversion

link to free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855117/

Gait and Climbing: Part 1

Lucid Dreaming is the name of a rock in the Buttermilks of Bishop, California. This is no ordinary rock. It is a V15. Summiting this rock is basically only 3 moves off of 3 holds, from your fingertips. The remainder of the climb is sliced bread. If you can do the 3, you can get to the top. The problem is, only a handful of people in the world can do it. How hard can this be, after all you start sitting down.

Strength, stability, mobility, endurance, skill, experience, movement patterns … . it is all here, today, on The Gait Guys blog.

Author: Dr. Shawn Allen

There are things that other people can do in life that rattle your brain. These are tasks that these individuals make look fairly simple, but in actuality are nearly impossible to the average person. The honest fact is that many of us could do many of these things to a degree if we would dedicate a portion of our day to building the engine to perform these tasks, but the truth is that many of us would rather sit down and be entertained than get up and struggle.

Here on The Gait Guys blog, bipedal and quadrupedal gait has been discussed for over 5 years. Discussions have gone deep into the strange quadrupedal gait of Uner Tan Syndrome and have delved into the critical neurology behind CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs. We have gone on and on about arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during walking running gaits.

Today I will look briefly at the interconnected arm and leg function in a high functioning human arguably one of the best new hot shots in climbing, Alex Megos. This year the German, as seen in this video link today, managed to summit Lucid Dreaming, a V15 in the Buttermilks of Bishop, California. Hell, you can say that this is just a big boulder, but there are not many V15s in the world like this one. Only a few of the very best in the world have even tried this rock, and you can count even fewer who have reached the summit. So, what does V15 mean to you? “virtually impossible” just about sums it up. Watch the video, this V15 starts from a “sit-start”, many folks wouldn’t even get their butts off the ground to complete the first move, that is how hard this is. Watch the video, if this does not cramp your brain, you perhaps you don’t have one.

Are there possible neurologic differences in climbers such as Megos as compared to other quadruped species? Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL(quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”

As we all know, the interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Megos however, we need to keep in mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates, in those with Uner Tan Syndrome and during our “bear crawl” challenges in our gyms. This should be obvious to the observer in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences. To be more specific, a climber must reduce fall risk by attempting to keep the COM within the 4 limbs while remaining close to the same surface plane as the hands and feet (mountain) while a primate, human or Uner Tan person will choose to “tent up” the pelvis and spine from the surface of contact which narrows the spreading of the 4 contact points. Naturally, this “tenting up” can be reduced, but the exercise becomes infinitely more difficult, to the point that most cannot quadrupedally ambulate more than a very short distance. I will discuss this concept in Part 2 of this series on climbing. If you study childhood development and crawling patterns, you need to be familiar with UTS (search our blog, save yourself the time), the flaws in the neurology behind the "Bird Dog” rehab pattern, and crawling mechanics … and of course, study climbers.

Some research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination. This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns. What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.

The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and progressive quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. Certainly I need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. I will keep you posted. Be sure to read my 3 part series on Uner Tan Syndrome, here on The Gait Guys blog. Some of today’s blog is rehash of my older writings, naturally I am setting the stage for “Part 2″ of Climbing.

- Dr. Shawn Allen

References:

Shapiro L. J., Raichien D. A. (2005). Lateral sequence walking in infant papio cynocephalus: implications for the evolution of diagonal sequence walking in primates. Am. J. Phys. Anthropol.126, 205–213 10.1002/ajpa.20049

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi S, Schena F, Tosi P, Ivanenko YP

J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.

Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs

While out cross country skiing after a few inches of fresh fallen snow it dawned on me, especially when going uphill on my cross-country skis, lifting your toes up definitely pushes the head of the first metatarsal down and helps you to gain more purchase with the scales on the bottom of the skis. It also helps to press the center portion of the camber of the ski downward so that you can get better traction. Thinking about this further, lifting your toes up also helps you to engage your glutes to a greater degree.

Try this: stand comfortably with your knees slightly flexed. Lift up your toes leaving the balls of your feet on the ground. Do you feel the first metatarsal head going down and making better contact with the ground? Can you feel your foot tripod between the head of the first metatarsal, head of the fifth metatarsal and the calcaneus? Now let your toes go down. Squeeze your glute max muscles. You should still be able to fart so don’t squeeze the sphincter. You can palpate these muscles to see if you’re actually getting to them. You can do this by placing your hands on top of your hips with your fingers calling around forward like when your mom used to put her hands on her hips and yell at you. Now relax with your toes up again leaving the balls of your feet on the ground. Now engage your glutes. See how much easier it is?

Now stand with your feet flat on the ground and put your hands on your abs, specifically your external obliques. Now raise your right leg. Do you feel your external oblique engage? Now, lift your toes up leaving the balls of your feet on the ground. Now lift your leg. Do you feel how much more your abs engage?

Little tricks of the trade. That’s why you listen here and why your patients/clients come to see you. Now go out and do it!

Dr. Ivo, one of The Gait Guys

#gaitanalysis, #crosscountryskiing, #skiing, hallux, #engage, #abs

Don't coach arm swing.

We often say that arm swing should not be coached.
Here are some of our deeper thoughts as to why we stand firm on this.

Look at this photo, there are lots of different arm swings in every group of runners. These differences are not choices for the most part, the arms are just doing what they must, based off of many parameters in a runner, things that are working right, and not so right.

To be more clear, aberrant arm swing is often a compensation to cope with other flawed mechanics elsewhere, things such as a weak core on one side, loss of thoracic lateral bend or rotation, altered limb stability patterns, hip stability challenges etc. Thus, it is almost foolish to change an arm swing that you do not like in you or your client, because often that is not the problem. Arm swing is a power producer, but it is also a huge ballast like appendage that is used to help maintain balance changes. So, look for all possible causes of what you so, that which looked aberrant, and fix those mechanical flaws first.

From Canton: "Current research has yet to determine how passive dynamics and active neural control contribute to upper limb swing during human locomotion. The present study aimed to investigate these contributions by restricting pelvis motion during walking, thereby altering the upward energy transfer from the swinging lower limbs."

Here at The Gait Guys we have discussed for years the principles of the antiphasic nature between the pelvis "girdle" and shoulder "girdles" in that they should move in opposite rotational planes, and yet be equal in their amplitude, and that when this occurs, arm and leg swings are mostly symmetrical, equal in amplitude and symmetrical in their swing planes. This study found that when the pelvis was restricted, that the ranges of motion of the shoulder and trunk, as well as the vertical trunk center of mass movement, were also reduced, as we have said many times in our writings and in quoting the research over the years. This study also supported our long standing position that arm swing is more of a passive phenomenon, yet with complex coupling of the upper and lower limb neural networks, but also strongly taking its queues from the trunk, pelvis and leg swing.

One final thought from us, coaches, especially sprint coaches, are still going to coach arm swing and force arm swing drills, the ones they want to see, to achieve more power. . . . sigh (we get it, speed is important, but there could be a cost to making the body do what is it naturally struggling to do cleanly). So, if you are going to employ these arm swing sprint drills, get someone to fix the aberrant patterns first, if you want to see fewer injuries. Otherwise, don't be surprised if you see in your runners more thoracic lean to one side, a head tilt to one side, athletes complaining of mid or low back or neck pain, tightness, shoulder pain and the list goes on. Forcing your desired coached arm swing pattern on a clients already compensated physiology may have some unwanted costs.
-Dr. Allen (of the gait guys)

From the -Canton and MacLellan paper:
"Relating shoulder muscle activities to upper limb kinematics suggested these muscles mainly acted eccentrically, providing evidence that passive elements are a significant factor in arm swing control. However, the conserved muscle activity patterns and temporal coupling of limb movements when pelvis motion was reduced are suggestive of an underlying active maintenance of the locomotor pattern via linked upper and lower limb neural networks."

Active and passive contributions to arm swing: Implications of the restriction of pelvis motion during human locomotion.Canton S1, MacLellan MJ2. Hum Mov Sci. 2018 Feb;57:314-323. doi: 10.1016/j.humov.2017.09.009. Epub 2017 Sep 25.

Can running/loading form changes last and translate from treadmill into the outdoor world ?

Research is here to inform us, give us concepts to guide protocols, clinical decision making, to make better choices for the patient right in front of us with their own unique set of variables (environment, choices, age, skills, strength, endurance, sport, history of injuries etc).

This is a study that makes us raise our eyebrows.
We sense that, as any reasonable clinician would, that a 8-session training protocol is not enough. You cannot win over old ingrained loading patterns that are well rooted in a mere 8 sessions.
The message we chose to take is that if changes were possible, if adaptations are possible, then time is the variable and patience must prevail. It can take months to make a new pattern unconsciously competent. It takes time.

The authors of this study said , "SIGNIFICANCE: Our findings indicated that a newly learned gait pattern may not fully translate to running outside of the laboratory environment."
We say, "it may not fully translate in 8 training sessions. Keep at it."

Can runners maintain a newly learned gait pattern outside a laboratory environment following gait retraining?Janet H Zhang, Zoe Y S Chan, Ivan P H Au, Winko W An, Roy T H Cheung

https://www.readbyqxmd.com/read/30658313/can-runners-maintain-a-newly-learned-gait-pattern-outside-a-laboratory-environment-following-gait-retraining

Walking and Running Require Greater Effort from the Ankle than the Knee Extensor Muscles.

Attached is an older video from a few years back , it is very similar in execution to the heel-rise ball squeeze exercise which is the precursor to this more functional engagement as shown in this video today.

The important premise is that you have to have command of the entire posterior compartment if you are to get safe, effective, efficient and adequate ankle plantarflexion. As we have discussed many times, if you do not have the requisite skills as shown in this video you are in trouble and ankle sprains and other functional pathologies are not unlikely to visit you. Additionally, without requisite posterior compartment endurance and an ability to engage what I like to refer to as "top end" strength in the heel rise is an asymmetrial loading issue and can lead to compensatory adaptations up the kinetic chain. Make no mistake, the load will go somewhere, and thus the work will be done somewhere. In this video you should be able to clearly see and understand that one must be able to achieve top end posturing and have command of lateral and medial forefoot loading responses and challenges if clean forward function and power is to be achieved, and injuries from extremes of motion medially and laterally are to be avoided. Furthermore, as eluded to here and in several of our podcasts (and in the study included below), an inability to achieve top end posturing will lead to changes in forefoot loading, may spill over into endurance challenges prematurely in the posterior mechanism, and create changes in the timing of the gait cycle (things like premature or delayed heel rise, premature or delayed forefoot loading, recruitment of other components of the posterior chain just to name a few). This parsing and sharing of loads and responsibilities is laid out in the Kulmala study referenced today. The study could be extrapolated to say, I believe, that particularly in sprinting, a failure to achieve top end heel rise through effective posterior mechanism contraction, will change the load sharing between the posterior compartment and the quadriceps. After all, if the calf is weak, the ankle is not in as much plantarflexion, this could mean more knee flexion and thus raise demands on the quadriceps, logically changing knee mechanics. This is exactly why we spend so much time at every patient visit looking for full range of motion at the joints and then determine the skill, endurance and strength of the associated muscles in supporting that range. Then, of course, comparing this function to the opposite limb. Symmetry is not everything, but it is definitely a major factor in safe efficient and injury free locomotion.

* Please give great thought to the part in the video where I discuss the drop phase in jumping. All too often we at looking for the propulsive mechanics and forget that a failure there will also be represented during the adaptive phase. Ankle sprains rarely occur from propulsive pushing off, they occur from a failure to properly reacquaint the foot to the ground on the following step.
-Dr. Shawn Allen, one of the gait guys.

In this study the authors noted:
"During walking, the relative effort of the ankle extensors was almost two times greater compared with the knee extensors. Changing walking to running decreased the difference in the relative effort between the extensor muscle groups, but still, the ankle extensors operated at a 25% greater level than the knee extensors. At top speed sprinting, the ankle extensors reached their maximum operating level, whereas the knee extensors still worked well below their limits, showing a 25% lower relative effort compared with the ankle extensors."

And concluded that:
"Regardless of the mode of locomotion, humans operate at a much greater relative effort at the ankle than knee extensor muscles. As a consequence, the great demand on ankle extensors may be a key biomechanical factor limiting our locomotor ability and influencing the way we locomote and adapt to accommodate compromised neuromuscular system function."

Med Sci Sports Exerc. 2016 Nov;48(11):2181-2189. Walking and Running Require Greater Effort from the Ankle than the Knee Extensor Muscles. Kulmala JP1, Korhonen MT, Ruggiero L, Kuitunen S, Suominen H, Heinonen A, Mikkola A, Avela J.
https://www.ncbi.nlm.nih.gov/pubmed/27327033

https://youtu.be/8T9UzOaYxmo

the gait guys
#gait, #gaitproblems, #thegaitguys, #gaitanalysis, #heelrise, #calfstrength, #toeoff, #forefootloading, #metatarsalgia, #inversionsprain